Healthcare Provider Details

I. General information

NPI: 1699711101
Provider Name (Legal Business Name): HENRY FORD HEALTH SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 05/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7800 W OUTER DR STE 240
DETROIT MI
48235-3458
US

IV. Provider business mailing address

7800 W OUTER DR STE 240
DETROIT MI
48235-3458
US

V. Phone/Fax

Practice location:
  • Phone: 313-653-2323
  • Fax: 313-653-2022
Mailing address:
  • Phone: 313-653-2323
  • Fax: 313-653-2022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number5301007269
License Number StateMI

VIII. Authorized Official

Name: KIM RICHARDS
Title or Position: PHARMACIST CLINICAL COORD
Credential: RPH MBA
Phone: 303-653-2323